JDH Site Safety Audit

• Job #:

• Customer:

• Conducted on

  Date

• Prepared by

• Location
  Address

• Supervisor:

• Personnel:

• Project Manager:

• Equipment

Part 1: JOB SITE DOCUMENTATION

• A. Was the Daily Job Safety Analysis form filled out and on site?

  Yes

  No

  N/A

• B. Are the applicable safety signs posted?

  Yes

  No

  N/A

• C. Is there a competent person on site?

  Yes

  No

  N/A

• D. Is someone on site certified in First Aid / CPR / BBP?

  Yes

  No

  N/A

• E. Has the emergency data form been filled out and posted?

  Yes

  No

  N/A

• F. Is there a documented site-specific direction for emergency rescue on site?

  Yes

  No

  N/A

• G. If employees are exposed to a fall, is a documented rescue plan and equipment on site?

  Yes

  No

  N/A

• H. Are SDS's available for the material being used on site?

  Yes

  No

  N/A

• I. Is there a documented procedure for any overhead electrical hazards?

  Yes

  No

  N/A

Part 2: JOB SITE CONDITIONS (INCLUDING ENVIRONMENTALS)

• A. Is the work site clean of trash?

  Yes

  No

  N/A

• B. Are materials stored properly and orderly?

  Yes

  No

  N/A

• C. Are measures taken to prevent access by unauthorized personnel on site?

  Yes

  No

  N/A

• D. Are areas barricaded or taped off as required?

  Yes

  No

  N/A

• E. Is drinking water available?

  Yes

  No

  N/A

• F. Are chemical, flammable, and combustible liquids stored properly? (I.e. No plastic gas cans)

  Yes

  No

  N/A

• G. Are fire extinguishers of the appropriate size and type available, and with current inspection tags?

  Yes

  No

  N/A

Part 3: PPE

• A. Are employees wearing hard hats?

  Yes

  No

  N/A

• B. Are employees wearing proper work boots?

  Yes

  No

  N/A

• C. Are safety glasses being used? (if applicable)

  Yes

  No

  N/A

• D. Are employees wearing gloves? (if applicable)

  Yes

  No

  N/A

• E. Are employees dressed in appropriate work clothing?

  Yes

  No

  N/A

• F. Is hearing protection being used? (if applicable)

  Yes

  No

  N/A

Part 4: FALL PROTECTION EQUIPMENT & USE

• A. Do employees that are exposed to falls, have documented training?

  Yes

  No

  N/A

• B. Is fall protection equipment being inspected daily and documented?

  Yes

  No

  N/A

• C. Is fall protection equipment in working condition?

  Yes

  No

  N/A

• D. If the employees are using fall protection, are they attached 100%?

  Yes

  No

  N/A

• E. Is the proper equipment on site to complete the task?

  Yes

  No

  N/A

Part 5: RF

• A. Have RF hazards been considered? (if applicable)

  Yes

  No

  N/A

• B. Is there a procedure in place to account for RF exposure if there is a possibility of overexposure? (if applicable)

  Yes

  No

  N/A

Part 6: ELECTRICAL (INCLUDING OVERHEAD)

• A. Are employees familiar with Lock Out / Tag Out / Try Out procedures?

  Yes

  No

  N/A

• B. Is the tower grounded during construction? (if applicable)

  Yes

  No

  N/A

• C. Are electrical panels covered when not being worked on?

  Yes

  No

  N/A

• D. Are (GFCI's) in use? (if applicable)

  Yes

  No

  N/A

• E. Are extension cords in good condition?

  Yes

  No

  N/A

• F. Has the Power Company been notified? (if applicable)

  Yes

  No

  N/A

• G. Is GFCI on the generator operational?

  Yes

  No

  N/A

Part 7: CRANES

• A. Are boom trucks or cranes properly cribbed?

  Yes

  No

  N/A

• B. Is annual inspection tag current or inspection report available?

  Yes

  No

  N/A

• C. Is the crane operator qualified and carrying an operator's certificate?

  Yes

  No

  N/A

• D. Are the load charts posted and readily available to crane operator?

  Yes

  No

  N/A

• E. Is the headache ball properly marked?

  Yes

  No

  N/A

• F. Is end connection properly secured?

  Yes

  No

  N/A

• G. Are daily inspections being conducted and documented?

  Yes

  No

  N/A

• H. Are two-way radios being tested daily, if being used?

  Yes

  No

  N/A

• I. Is a hand signal chart posted and visible to all personnel on site?

  Yes

  No

  N/A

• J. Has personnel lifting plan been filled out and on site? (if applicable)

  Yes

  No

  N/A

Part 8: WELDING

• A. Is the correct PPE being utilized and in good condition?

  Yes

  No

  N/A

• B. Is there proper ventilation or air flow?

  Yes

  No

  N/A

• C. Are Oxygen and Acetylene Tanks properly tied down and secured?

  Yes

  No

  N/A

• D. Is there an appointed fire watch present?

  Yes

  No

  N/A

• E. Is the welder qualified? (Certified through training)

  Yes

  No

  N/A

Part 9: HOISTS, MAN LIFTS, SCISSOR LIFTS & BUCKET TRUCKS

• A. Are daily inspections being completed with documentation on site?

  Yes

  No

  N/A

• B. Is operator qualified? (Certified through training or qualified through experience)

  Yes

  No

  N/A

• C. Are load charts posted and readily available to hoist operator?

  Yes

  No

  N/A

• D. Is there an operator's manual of the unit on site?<br>

  Yes

  No

  N/A

• E. Are there headache ball markings?

  Yes

  No

  N/A

• F. Is end connection properly secured?

  Yes

  No

  N/A

• G. Are all hoists secured and properly anchored for the load intended?

  Yes

  No

  N/A

• H. Are controls clearly identified?

  Yes

  No

  N/A

• I. Are controls easily accessible to the operator?

  Yes

  No

  N/A

• J. Is the hour meter operational and functioning properly?

  Yes

  No

  N/A

• K. Are two-way radios being tested daily? (if applicable)

  Yes

  No

  N/A

• L. Are all exposed moving parts properly guarded?

  Yes

  No

  N/A

• M. Is a hand signal chart posted and visible to all personnel on site?

  Yes

  No

  N/A

• N. Is Fall Protection being utilized and serviceable?

  Yes

  No

  N/A

Part 10: PERSONNEL LIFTING

• A. Is the hoist approved for lifting personnel?

  Yes

  No

  N/A

• B. Has a pre-lift meeting been held, documented and made available on site?

  Yes

  No

  N/A

• C. In the pre-lift plan, was the trail lift completed mad documented?

  Yes

  No

  N/A

• D. If a personnel platform is on site, does it have an identification plate with the proper data in place?

  Yes

  No

  N/A

• E. If a gin pole is being used, does it have a load chart?

  Yes

  No

  N/A

Part 11: CATHEADS

• A. Is the cathead mounted properly and securely on sufficient anchorage?

  Yes

  No

  N/A

• B. Are operator controls in good working condition? (Foot Pedal or Switch)

  Yes

  No

  N/A

• C. Is rope of sufficient size, strength, and type for the load being lifted?

  Yes

  No

  N/A

• D. Is S.W.L. visible on the cathead?

  Yes

  No

  N/A

• Is the manufacturer's labeling indicating load rating legible?

  Yes

  No

  N/A

• F. Is the capstan head free of grooves?

  Yes

  No

  N/A

Part 12: RIGGING & BLOCKS

• A. Are proper rigging practices being utilized?

  Yes

  No

  N/A

• B. Are tags on synthetic slings legible?

  Yes

  No

  N/A

• C. Are synthetic slings in good condition?

  Yes

  No

  N/A

• D. Is rigging equipment being inspected daily and the inspection documented?

  Yes

  No

  N/A

• E. Are safeties on all hooks in good condition?

  Yes

  No

  N/A

• F. Are tag lines in working condition?

  Yes

  No

  N/A

Part 13: GIN POLES

• A. Is the pole rigging in good condition? (if visible)

  Yes

  No

  N/A

• B. Does the pole have an identification tag? (if visible)

  Yes

  No

  N/A

• C. Is the pole load chart on site that matches the pole?

  Yes

  No

  N/A

• D. Is the pole pre-job inspection form filled out and on site or readily available?

  Yes

  No

  N/A

• E. Does the sheave in the Rooster Head match the wire rope? (if visible)

  Yes

  No

  N/A

Part 14: TRENCH & EXCAVATION

• A. Are open holes properly guarded?

  Yes

  No

  N/A

• B. If employees are in the trench, is it properly sloped and/or benched?

  Yes

  No

  N/A

• C. Is the proper equipment on site to perform the work?

  Yes

  No

  N/A

• D. Are trench boxes being used and in good condition?

  Yes

  No

  N/A

• E. If employees are in the trench, is there proper entry and egress?

  Yes

  No

  N/A

Part 15: HEAVY EQUIPMENT

• A. Is back-up alarm working properly?

  Yes

  No

  N/A

• B. Is Roll Over Protection installed and in good condition?

  Yes

  No

  N/A

• C. Are Hazard Lights working properly?

  Yes

  No

  N/A

• D. Are buckets and booms free of cracks and defects?

  Yes

  No

  N/A

• E. Are personnel clear of the danger area or working radius?

  Yes

  No

  N/A

• F. Are seat belts being utilized while equipment is in operation

  Yes

  No

  N/A

Part 16: HAND / POWER TOOLS

• A. Are electrical tools in good condition?

  Yes

  No

  N/A

• B. Are the cords in good condition?

  Yes

  No

  N/A

• C. Are they properly grounded or double insulated?

  Yes

  No

  N/A

• D. Are proper guards in place?

  Yes

  No

  N/A

Part 17: LADDERS

• A. Are units well maintained and in good working order?

  Yes

  No

  N/A

• B. Are ladders at the proper slope? (4:1 Ratio)

  Yes

  No

  N/A

• C. Does the ladder extend 36 inches past the landing?

  Yes

  No

  N/A

• D. Is the ladder stable, on good ground?

  Yes

  No

  N/A

• E. Are ladders properly secured? (Tower Access)

  Yes

  No

  N/A

Part 18: VEHICLES

• A. Is vehicle interior clean?

  Yes

  No

  N/A

• B. Is vehicle exterior clean? ( if conditions are suitable)

  Yes

  No

  N/A

• C. Does the vehicle have a fire extinguisher with a rating of 2.5 ABC?

  Yes

  No

  N/A

• D. Is the fire extinguisher location identified?

  Yes

  No

  N/A

• E. Is a well-stocked first-aid kit located in the vehicle?

  Yes

  No

  N/A

• F. Is the first-aid location marked and identified?

  Yes

  No

  N/A

• G. Is safety form S-007 in the glove box in case of an accident?

  Yes

  No

  N/A

• H. Has a annual inspection report been completed for the vehicle?

  Yes

  No

  N/A

Part 19: D.O.T Drivers and Vehicles

• A. Is CDL valid for equipment being used?

  Yes

  No

  N/A

• B. Do drivers have CDL / DOT medical cards?

  Yes

  No

  N/A

• C. Is Drivers Daily Log ( Hours of Service) current? (if applicable)

  Yes

  No

  N/A

• D. Are Daily Vehicle Inspection Reports (DVIR) current?

  Yes

  No

  N/A

• E. Is vehicle properly labeled on each side?

  Yes

  No

  N/A

• F. Are emergency reflectors in the vehicle?

  Yes

  No

  N/A

Part 20: OVERALL IMPRESSION OF VISIT

• OUTSTANDING

• ABOVE AVERAGE

• AVERAGE

• BELOW AVERAGE

Amount of Time Spent on this Visit?

• HOURS

• DAYS

CORRECTIVE ACTIONS

• Necessary To Follow Up With Written Documnentation

  Yes

  No

  N/A

• If Any Deficiencies Were They Corrected Immediately?

  Yes

  No

  N/A

• Information was Reviewed With:

• SUPERVISOR

• CREW

• Supervisor Signature

  Sign

LIST OF DEFICIENCIES

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

• ITEM #

• Compliance Completed By:

• Noted Deficiency:

• Course of Action:

The Department Director states compliance of all listed deficiencies by submitting this electronic form to the Safety Director.

• Management Comments:

• Safety Director:

  Sign

• Division Manager:

  Sign

• Division Director:

  Sign